The Vital Approach - Anamnesis, Step 2: Questions for details
- Anne Vervarcke, www.thewhiteroom.be ,http://walkforhomeopathy.wordpress.com/,
http://annevervarcke.com/blog/
When the patient defines the territory we must ensure that we precisely determine the borders, and therefore ask questions about the topics that the patient just discussed. If he said he has three problems, we’ll ask anything we can think of about these three problems. Keep in mind that those questions should be as general as possible, they should not to lead or guide the patient in any direction. General questions mean questions without any suggestion or interpretation. When the patient said: ‘This knee is causing trouble’, the question should be: ‘Can you tell me more about the trouble?’ not: ‘What kind of pain do you have?’. This way of questioning the patient is very different from that used in other therapeutic modalities and the homeopathic student needs to become familiar with it.. The focus of the case-taking should be on helping the patient describe what is experienced, not explaining why the problem is there.
When the patient has told the homeopath everything about the what, the how, the when and the where of the problem, very frequently he makes the topic broader and moves from ‘my problem’ to ‘me’. At this point, the patient will give the homeopath his own concerns, anxieties, worries, ideas how and why it started and previous similar events or feelings. In this way we seamless go from ‘the complaint’ to ‘the patient’ and are given parts of his life story.
Even if we don’t ask many questions, this part of the consultation tends to be loaded with so many stories that it can be hard to discern the qualitative from the quantitative information. It requires the homeopath’s full attention because, as mentioned before, there is always a reason why the patient chose just that example out of the million other things that have happened in his life. The art is to spot the particular way of telling this story and the spontaneous remarks that come with it.
Examples of this might be: a common expression but in the wrong place; a sequence of words with one illogical one, not fitting or repetitive; or an odd word or an unexpected, even wrong expression. In short: all those things that would not have been said by anyone else, and which means that they are the signature of the patient: his frequency pattern
The homeopath at this point should restrain himself from jumping to conclusions when he hears something familiar: a rubric, keynote, a hint he recognizes as belonging to a certain remedy. All patients will give you many if the consultation is long enough! But these are nothing but attributes that we all have in abundance, without having connection to the vital disturbance: they are just local phenomena. We can’t go on giving everybody who prefers soft boiled eggs, Calcarea carb., can we?
On the other hand we should not ignore hints to remedies, not at all! They must be registered somewhere in the back of our mind and if more rubrics are added as the case unfolds, then of course we can give the remedy. But we should avoid getting fixed on a remedy as soon we hear a keynote, because then our mind tends to delete everything which the patient says that doesn’t fit our idea and only hear what will confirm it.
A good method to dispense with a fixed idea of a remedy is to put that remedy to the test. As an example: a woman came for an intake in the Master Class for severe cramps all over her body. She was talking about her job and how much stress she always had. As a teacher she was given a difficult schedule, she had quarrels with the director, started a case with the union and felt wronged by everybody. But she was firm and defensive and fought for her rights. It was difficult not to think about Cuprum in her case. Instead of asking more about Cuprum topics like: ‘What about finance?’, ‘Can you tell me more about the importance of work?’ or ‘What does this health problem mean for you?’, which would all lead to predictable answers in light of the topics just discussed, I tried something completely different. When noting down her personal information, she told me that she had two children and that the oldest boy was handicapped. Since she didn’t mention him in the consultation so far, I asked her about him. She answered that since she is a perfectionist, it was difficult for her to accept. She gave a few more sentences, and then somehow made an association in her mind and started talking about the neighbors. Their garden bordered on the patient’s garden and the neighbor’s gas tank spoiled their view. She wrote letters to the municipality and even took a lawyer. Within a moment of being asked about her handicapped son she was giving me another image of a bossy person, vigorously fighting for what she thinks is right and should be forced by the law upon others. She spoke hardly a word about the boy! Well, this was strange, rare and peculiar for a mother and confirmed Cuprum. The difference was that now we were sure it was Cuprum, whereas when we ask Cuprum questions we will never know whether we ‘made’ the case ourselves or not.
In this part of the consultation, we encourage the patient to tell us about the topics he began with, but we don’t choose other areas. If he doesn’t go there we don’t have to go there.
The encouraging questions are all aimed at Level 5: ‘How did you experience this?’
It shouldn’t always be put literally in these words because it might sound quite artificial, better to use as few words as possible and to make your question as broad as possible: ‘How was it?’, ’Can you tell a bit more?’, ‘Can you describe this?’, ‘When you say: ‘grief’ what do you mean?’.
One can repeat a question more than once. Many beginning homeopaths don’t dare to do so because they are afraid they may look stupid. They think the patient will think they didn’t listen or they don’t understand the simplest thing. Sometimes they are afraid a patient will lose his patience or will never come back. To avoid this it might be wise to introduce the repetition of the question with a little explanation: ‘I know you told me this before but could you describe once more how it was for you when your daughter left home? Every time you tell me something, some new words or expressions might come up and I want to have the picture as complete as possible’. When a patient says: ‘I don’t know’, it is a good idea to give him a little time to think: often it is nothing but an introduction to the answer. With children I’d even press a little bit and say: ‘Well, think a bit then’.
The middle part of the interview mostly gathers information: the patient tells you part of his life story or at least some events that left an impression on him. The fact that he chose to bring up these topics means they have something to do with the vital sensation. It is always the patient who links everything together. We shouldn't use our imagination to connect parts of the story together because we risk making a creative prescription that has nothing to do with the patient.
For instance: we feel the patient behaves like a frog: he loves nature and moist weather, he has big eyes and a big mouth, he is kind of jumpy in his narration and he burps like a frog. This may all be true, but if the patient didn't give kingdom and subkingdom words or even better, proving symptoms, we have to be very careful with such prescriptions.
That is why I recommend asking questions that are as general as possible, checking the answer three times and putting the idea to the test at another point in the consultation.
Also: never assume you know what the patient means: you don't until the patient has told you. If he uses the word ‘emptiness’, what does he mean? You have to ask! Silly as it may seem at the beginning, the value will soon be obvious Just ask three patients who used the word ‘injustice’ what they meant by this; the answers will be completely different. When a patient talks about tension, stress, difficulty, problem, being depressed, always ask: ‘What do you mean?’ If you ask how they feel about something and the answer is ‘bad’, you can ask: ‘I understand this makes you feel bad but how is it that?’ If they say: ‘It is difficult’, then the homeopath can ask: ‘This bad and difficult feeling: can you describe it a bit more?’. It is necessary to keep asking until you feel the answer is authentic and personal, and not something that everybody says. It may be a word, an example, a comparison, an expression, as long as it expresses the deepest feeling if the patient.
Another very important reason to inquire deeply is to see if the word the patient chose to use 'holds'. For instance, the patient says: ‘I have an empty feeling inside’. We could stop here and with great self-confidence prescribe a mineral remedy, but if we ask what the patient means by ‘emptiness’ and the answer is something like: ‘It's a feeling of being left alone in a dark wood’, then we have to go on asking: ‘And how is that?’. Let's say the patient answers: ‘Scary’, then this is Level 3, and we have just double-checked whether the emptiness was a Level 5 sensation. When we first asked we may have been given an image on Level 4, but when we asked again, something else came up. Now suppose we go on and ask: ‘This left alone, scary and empty feeling, how is this for you?’, and the patient says: ‘I feel completely lost and bewildered’, we must conclude that the ‘emptiness’ doesn't hold and our questioning has led to something else. ‘Lost and bewildered’ sounds like a deeper experience and we must check during consultation if this experience is repeated.
It is another reason why consultations take time: to be sure we must check, otherwise we will simply be guessing, going by the words without knowing exactly what the patient meant by them, and furthermore we will not have the context in which the words were said.
Some cases are time consuming because the patient is loquacious and describes every event in his life in all its detail. Or he may have read a book on homeopathy where it was stated that the homeopath needs to know all about his character and preferences. This can lead to what I would call ‘horizontal information’: more of the same.
A homeopath needs to go vertically through the levels. A good way to switch from this horizontal information is to take the first opportunity to say: ‘I understood this and this and that happened and you were feeling such and such, can you tell me how it is for you to be in those situations?’. The homeopath can precise what the patient told him and then make the leap to Level 5. It’s a direct question but it is based the story told, not on a single word.
Sometimes the patient jumps from one subject to another but certain words are repeated.. Then the homeopath can pick out the repeated word and ask the patient to define it, but the word needs to have come up at least three times. Let’s say the patient mentions the words ‘doubt’, which is very common. This could be triggered by his chief complaint, for instance vertigo. If the word pops up again, for instance in a relationship problem, it means it is also felt on a completely different level and in different circumstances. If the patient then tells another anecdote where the final conclusion is doubt, for instance doubting his capacity to financially manage on his own, then we can ask: ‘when you say doubt, what do you mean?’.
If it wasn’t clear by then, the kingdom will probably be revealed by the patient’s answer to this question.
In general, the kingdom, miasm and often the subkingdom, are clear when the second part of the consultation is done, usually after approximately an hour and a half of case-taking.
http://annevervarcke.com/blog/
When the patient has told the homeopath everything about the what, the how, the when and the where of the problem, very frequently he makes the topic broader and moves from ‘my problem’ to ‘me’. At this point, the patient will give the homeopath his own concerns, anxieties, worries, ideas how and why it started and previous similar events or feelings. In this way we seamless go from ‘the complaint’ to ‘the patient’ and are given parts of his life story.
Even if we don’t ask many questions, this part of the consultation tends to be loaded with so many stories that it can be hard to discern the qualitative from the quantitative information. It requires the homeopath’s full attention because, as mentioned before, there is always a reason why the patient chose just that example out of the million other things that have happened in his life. The art is to spot the particular way of telling this story and the spontaneous remarks that come with it.
Examples of this might be: a common expression but in the wrong place; a sequence of words with one illogical one, not fitting or repetitive; or an odd word or an unexpected, even wrong expression. In short: all those things that would not have been said by anyone else, and which means that they are the signature of the patient: his frequency pattern
The homeopath at this point should restrain himself from jumping to conclusions when he hears something familiar: a rubric, keynote, a hint he recognizes as belonging to a certain remedy. All patients will give you many if the consultation is long enough! But these are nothing but attributes that we all have in abundance, without having connection to the vital disturbance: they are just local phenomena. We can’t go on giving everybody who prefers soft boiled eggs, Calcarea carb., can we?
On the other hand we should not ignore hints to remedies, not at all! They must be registered somewhere in the back of our mind and if more rubrics are added as the case unfolds, then of course we can give the remedy. But we should avoid getting fixed on a remedy as soon we hear a keynote, because then our mind tends to delete everything which the patient says that doesn’t fit our idea and only hear what will confirm it.
A good method to dispense with a fixed idea of a remedy is to put that remedy to the test. As an example: a woman came for an intake in the Master Class for severe cramps all over her body. She was talking about her job and how much stress she always had. As a teacher she was given a difficult schedule, she had quarrels with the director, started a case with the union and felt wronged by everybody. But she was firm and defensive and fought for her rights. It was difficult not to think about Cuprum in her case. Instead of asking more about Cuprum topics like: ‘What about finance?’, ‘Can you tell me more about the importance of work?’ or ‘What does this health problem mean for you?’, which would all lead to predictable answers in light of the topics just discussed, I tried something completely different. When noting down her personal information, she told me that she had two children and that the oldest boy was handicapped. Since she didn’t mention him in the consultation so far, I asked her about him. She answered that since she is a perfectionist, it was difficult for her to accept. She gave a few more sentences, and then somehow made an association in her mind and started talking about the neighbors. Their garden bordered on the patient’s garden and the neighbor’s gas tank spoiled their view. She wrote letters to the municipality and even took a lawyer. Within a moment of being asked about her handicapped son she was giving me another image of a bossy person, vigorously fighting for what she thinks is right and should be forced by the law upon others. She spoke hardly a word about the boy! Well, this was strange, rare and peculiar for a mother and confirmed Cuprum. The difference was that now we were sure it was Cuprum, whereas when we ask Cuprum questions we will never know whether we ‘made’ the case ourselves or not.
In this part of the consultation, we encourage the patient to tell us about the topics he began with, but we don’t choose other areas. If he doesn’t go there we don’t have to go there.
The encouraging questions are all aimed at Level 5: ‘How did you experience this?’
It shouldn’t always be put literally in these words because it might sound quite artificial, better to use as few words as possible and to make your question as broad as possible: ‘How was it?’, ’Can you tell a bit more?’, ‘Can you describe this?’, ‘When you say: ‘grief’ what do you mean?’.
One can repeat a question more than once. Many beginning homeopaths don’t dare to do so because they are afraid they may look stupid. They think the patient will think they didn’t listen or they don’t understand the simplest thing. Sometimes they are afraid a patient will lose his patience or will never come back. To avoid this it might be wise to introduce the repetition of the question with a little explanation: ‘I know you told me this before but could you describe once more how it was for you when your daughter left home? Every time you tell me something, some new words or expressions might come up and I want to have the picture as complete as possible’. When a patient says: ‘I don’t know’, it is a good idea to give him a little time to think: often it is nothing but an introduction to the answer. With children I’d even press a little bit and say: ‘Well, think a bit then’.
The middle part of the interview mostly gathers information: the patient tells you part of his life story or at least some events that left an impression on him. The fact that he chose to bring up these topics means they have something to do with the vital sensation. It is always the patient who links everything together. We shouldn't use our imagination to connect parts of the story together because we risk making a creative prescription that has nothing to do with the patient.
For instance: we feel the patient behaves like a frog: he loves nature and moist weather, he has big eyes and a big mouth, he is kind of jumpy in his narration and he burps like a frog. This may all be true, but if the patient didn't give kingdom and subkingdom words or even better, proving symptoms, we have to be very careful with such prescriptions.
That is why I recommend asking questions that are as general as possible, checking the answer three times and putting the idea to the test at another point in the consultation.
Also: never assume you know what the patient means: you don't until the patient has told you. If he uses the word ‘emptiness’, what does he mean? You have to ask! Silly as it may seem at the beginning, the value will soon be obvious Just ask three patients who used the word ‘injustice’ what they meant by this; the answers will be completely different. When a patient talks about tension, stress, difficulty, problem, being depressed, always ask: ‘What do you mean?’ If you ask how they feel about something and the answer is ‘bad’, you can ask: ‘I understand this makes you feel bad but how is it that?’ If they say: ‘It is difficult’, then the homeopath can ask: ‘This bad and difficult feeling: can you describe it a bit more?’. It is necessary to keep asking until you feel the answer is authentic and personal, and not something that everybody says. It may be a word, an example, a comparison, an expression, as long as it expresses the deepest feeling if the patient.
Another very important reason to inquire deeply is to see if the word the patient chose to use 'holds'. For instance, the patient says: ‘I have an empty feeling inside’. We could stop here and with great self-confidence prescribe a mineral remedy, but if we ask what the patient means by ‘emptiness’ and the answer is something like: ‘It's a feeling of being left alone in a dark wood’, then we have to go on asking: ‘And how is that?’. Let's say the patient answers: ‘Scary’, then this is Level 3, and we have just double-checked whether the emptiness was a Level 5 sensation. When we first asked we may have been given an image on Level 4, but when we asked again, something else came up. Now suppose we go on and ask: ‘This left alone, scary and empty feeling, how is this for you?’, and the patient says: ‘I feel completely lost and bewildered’, we must conclude that the ‘emptiness’ doesn't hold and our questioning has led to something else. ‘Lost and bewildered’ sounds like a deeper experience and we must check during consultation if this experience is repeated.
It is another reason why consultations take time: to be sure we must check, otherwise we will simply be guessing, going by the words without knowing exactly what the patient meant by them, and furthermore we will not have the context in which the words were said.
Some cases are time consuming because the patient is loquacious and describes every event in his life in all its detail. Or he may have read a book on homeopathy where it was stated that the homeopath needs to know all about his character and preferences. This can lead to what I would call ‘horizontal information’: more of the same.
A homeopath needs to go vertically through the levels. A good way to switch from this horizontal information is to take the first opportunity to say: ‘I understood this and this and that happened and you were feeling such and such, can you tell me how it is for you to be in those situations?’. The homeopath can precise what the patient told him and then make the leap to Level 5. It’s a direct question but it is based the story told, not on a single word.
Sometimes the patient jumps from one subject to another but certain words are repeated.. Then the homeopath can pick out the repeated word and ask the patient to define it, but the word needs to have come up at least three times. Let’s say the patient mentions the words ‘doubt’, which is very common. This could be triggered by his chief complaint, for instance vertigo. If the word pops up again, for instance in a relationship problem, it means it is also felt on a completely different level and in different circumstances. If the patient then tells another anecdote where the final conclusion is doubt, for instance doubting his capacity to financially manage on his own, then we can ask: ‘when you say doubt, what do you mean?’.
If it wasn’t clear by then, the kingdom will probably be revealed by the patient’s answer to this question.
In general, the kingdom, miasm and often the subkingdom, are clear when the second part of the consultation is done, usually after approximately an hour and a half of case-taking.
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